Relationships of Tubal Ligation to Endometrial Carcinoma Stage and Mortality in the NRG Oncology/Gynecologic Oncology Group 210 Trial

Felix, Ashley S.; Brinton, Louise A.; McMeekin, D. Scott; Creasman, William T.; Mutch, David G.; Cohn, David E.; Walker, Joan L.; Moore, Richard G.; Downs, Levi S.; Soslow, Robert A.; Zaino, Richard J.; Sherman, Mark E.

doi:10.1097/ogx.0000000000000241

Cited by 8 publications

(15 citation statements)

References 30 publications

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“…The reason for this is probably due to the insufficient duration of follow‐up for women having had surgery during the last two decades of the observational period (when laparoscopy became widely available) and the young age at which surgery is done. An inverse relation with cancer specific mortality also substantiates repeat findings of lower EC stages at the time of diagnosis in women with a prior tubal ligation …”

Section: Discussionsupporting

confidence: 72%

“…It is reasonable to assume that these potential sources of selection and reporting bias may have influenced the analyses. Retrospective studies have shown that tubal ligation influences metastatic spread and mortality among patients with endometrial carcinoma but have not addressed the primary preventive effect of tubal ligation per se …”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence suggest that having had a tubal ligation is associated with less advanced stages as well as lower risk of intraperitoneal metastatic spread at diagnosis of EC . Female sterilization remains the most common contraceptive method worldwide but the prevalence varies widely with almost 22% in the US and <10% in Europe .…”

Section: Introductionmentioning

confidence: 99%

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Association between tubal ligation and endometrial cancer risk: A Swedish population‐based cohort study

Falconer

Yin

Altman

2018

Intl Journal of Cancer

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Tubal ligation results in less advanced stages and lower risk of metastatic spread at diagnosis of endometrial cancer (EC) but the primary preventive effect of the procedure is unclear. In a Swedish nationwide population-based cohort study, we crosslinked registry data for tubal ligation, EC, and death for Swedish women between 1973 and 2010. All women were followed until EC, emigration, hysterectomy for non-cancerous reasons, death, or end of follow-up. Primary outcome was incidence of EC and secondary outcome overall survival. We calculated adjusted incidence rates (IR) per 100,000 person-years and hazard ratios (HR) using Cox regression models. A total of 35,711 cases of EC were identified among 5,385,186 women. The IR of EC among exposed was 17.7 (95% CI 15.7-19.9) versus 29.0 (95% CI 28.7-29.3) among unexposed (per 100,000 women years). Exposed individuals had significantly reduced risk of EC (HR 0.73, 95% CI 0.65-0.83). The mortality rate among women with EC was 72% lower in exposed compared to unexposed (IR 1,441; 95% CI 1,089-1,907 and IR 5,136; 95% CI 5,065-5,209, respectively) which following adjustment corresponded to a HR of 0.71 (95% CI 0.49-1.03). Tubal ligation was associated with lower risk of EC as well as mortality rates in women with EC. Elective tubal ligation may be adopted in future cancer preventive strategies but must be balanced against the irreversibility of the procedure, which preclude further unassisted reproduction.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Association between tubal ligation and endometrial cancer risk: A Swedish population‐based cohort study

Falconer

Yin

Altman

2018

Intl Journal of Cancer

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“…Full details regarding the NRG Oncology/GOG 210 Study design have been published elsewhere. 10 Briefly, the NRG Oncology/GOG 210 Study was conducted from September 22, 2003 to December 1, 2011 at 62 U.S. institutions. Prior to surgery (hysterectomy, bilateral salpingo-oophorectomy and lymph node sampling at the discretion of the treating provider), consenting patients completed a self-administered questionnaire that collected demographic and epidemiologic information.…”

Section: Study Populationmentioning

confidence: 99%

Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Felix

Brasky

Cohn

et al. 2017

Intl Journal of Cancer

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Non-Hispanic black (NHB) women are more likely to experience an endometrial carcinoma (EC) recurrence compared to non-Hispanic white (NHW) women. The extent to which tumor characteristics, socioeconomic status (SES) and treatment contribute to this observation is not well defined. In the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study we evaluated associations between race/ethnicity and EC recurrence according to tumor characteristics with adjustment for potential confounders. Our analysis included 3,199 NHW, 532 NHB and 232 Hispanic women with EC. Recurrence was documented during follow-up. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and EC recurrence in models stratified by histologic subtype (low-grade endometrioid, high-grade endometrioid, serous, mixed cell, carcinosarcoma, clear cell) or stage (I, II, III) and adjusted for age, SES, body mass index, smoking status and treatment. In histologic subtype-stratified models, higher EC recurrence was noted in NHB women with low-grade endometrioid (HR = 1.94, 95% CI = 1.21-3.10) or carcinosarcomas (HR = 1.66, 95% CI = 0.99-2.79) compared to NHWs. In stage-stratified models, higher EC recurrence was noted among NHB women with stage I (HR = 1.48, 95% CI = 1.06-2.05) and Hispanic women with stage III disease (HR = 1.81, 95% CI = 1.11-2.95). Our observations of higher EC recurrence risk among NHB and Hispanic women, as compared to NHW women, were not explained by tumor characteristics, SES, treatment or other confounders. Other factors, such as racial differences in tumor biology or other patient factors, should be explored as contributors to racial disparities in EC recurrence.

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“…A report of 4489 endometrial carcinomas found that TL was inversely associated with stage III and IV carcinomas and peritoneal metastasis but showed no independent association with improved survival as it might affect mortality mainly through its effects on stages. 12 Another report of 142 serous endometrial carcinomas found that although positive peritoneal cytology and stage IV disease were less frequent among women with TL, TL was associated with worse prognosis attributable to increased nodal metastases. 6 In the present study, we examined the associations between TL, peritoneal cytology, endometrial carcinoma stages, extrauterine metastasis, recurrence rate, and mortality in 562 patients with endometrial carcinoma including the strong predominant endometrioid carcinoma and other more aggressive subtypes (nonendometrioid carcinomas).…”

mentioning

confidence: 99%

Prior Tubal Ligation Might Influence Metastatic Spread of Nonendometrioid Endometrial Carcinoma

Li²,

Zhao³

et al. 2016

Int J Gynecol Cancer

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ObjectiveThe exfoliation of endometrial carcinoma might intraperitoneally spread through the fallopian tube. We analyzed the influence of prior tubal ligation (TL) in endometrial carcinoma to evaluate whether it can prevent the process and improve patients’ survival.MethodsA total of 562 patients with a diagnosis of endometrial carcinoma at the Peking University People’s Hospital between July 1995 and June 2012 were enrolled in this study. The patients were divided into 2 groups based on the presence or absence of prior TL. International Federation of Gynecology and Obstetrics stage distributions, recurrence rates, survival status, and histopathological findings were compared between the 2 groups. Kaplan-Meier estimates and log-rank tests were used to compare the survival status based on TL in the overall population and stratified by histopathological subtypes and International Federation of Gynecology and Obstetrics stages. Cox models analysis was used to estimate the hazard ratios and 95% confidence intervals for associations between TL and carcinoma-specific mortality. All statistical tests were 2-sided.ResultsOf the 562 patients, 482 (85.7%) had a diagnosis of endometrioid and 80 patients (14.2%) with nonendometrioid carcinoma. Tubal ligation was associated with negative peritoneal cytology in the total population (P = 0.015) and in patients with endometrioid carcinomas (P = 0.02) but not help to reduce carcinoma-specific mortality (P = 0.095 and P = 0.277, respectively). In the nonendometrioid group, TL was not only associated with negative peritoneal cytology (P = 0.004) but also with lower stage (P < 0.001) and lower recurrence rate(P < 0.005), resulting in improved prognosis (P = 0.022). In Cox models analysis adjusted for covariates, TL was inversely associated with lower endometrial carcinoma-specific mortality (hazard ratio, 0.47; 95% confidence interval, 0.14–2.6).ConclusionTubal ligation was associated with lower positive peritoneal cytology, stages, and recurrence rate, and improved prognosis among patients with nonendometrioid carcinoma. Tubal ligation might influence metastatic spread of nonendometrioid endometrial carcinoma. It could also help to reduce positive peritoneal cytology among patients with endometrioid carcinoma, but lacked prognostic significance.

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Relationships of Tubal Ligation to Endometrial Carcinoma Stage and Mortality in the NRG Oncology/Gynecologic Oncology Group 210 Trial

Cited by 8 publications

References 30 publications

Association between tubal ligation and endometrial cancer risk: A Swedish population‐based cohort study

Association between tubal ligation and endometrial cancer risk: A Swedish population‐based cohort study

Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Prior Tubal Ligation Might Influence Metastatic Spread of Nonendometrioid Endometrial Carcinoma

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